Effect Of Preventive Treatment With Drugs For BCIS On Haemodynamics And Oxygen Metabolism Of The Aged

Objective To observe the effect of preventive treatment with drugs for bone cement implantation syndrome on hemodynamic and oxygen metabolism in elderly patients undergoing hip replacement surgery.Methods Fifty-two elderly patients with American Society of Anesthesiologists classification status I to II scheduled for elective unilateral hip replacement under general anesthesia were randomly divided into two groups: Preventive medication group(group P) and Control group(group C). Each group had twenty-six patients. In both groups, an artery catheter connected to the Flo Trac/Vigileo hemodynamic monitoring system was inserted into the radial artery before anesthesia and a CVP catheter was inserted into the right internal jugular vein after anesthesia.Before induction of anesthesia, colloid was given in intraoperative fluid infusion of both groups depending on △ SV. Both groups used the intravenous inhalational anesthesia method to maintain BIS values between 40 and 60. Preventive medication was intravenous infusion with Dopamine in 3~5μg/(kg·min) and Methylprednisolone Sodium Succinate 1mg/kg before insertion of acrylic cement. Mean artery pressure(MAP), heart rate(HR), cardiac index(CI),stroke volume index(SVI), stroke volume variation(SVV) and systemic vascular resistance index(SVRI) were recorded under Flo Trac/Vigileo hemodynamic monitoring system before anesthesia(T0), after anesthesia(T1), before insertion of cement(T2), and 0min(TG0), 5min(TG1),10min(TG2) and 30min(TG3) after insertion of cement. Blood gas analysis was performed before insertion of cement, and 0, 5, 10, 30 min after insertion of cement, recorded the value of Pa O2,Sa O2, Scv O2 and Lac, worked out DO2 I.Results 1.Hemodynamic: Induction of anesthesia led to a significant fall in MAP, CI and SVI in both groups(P<0.05); but there was no significant difference between two groups(P>0.05).MAP, CI, SVI and SVRI of group C were significantly lower at the point of TG0,TG1 after insertion of cement than the values before insertion(P<0.05), but group P set a modest variation,shorter duration and faster recovery(P<0.05); Between the two groups, MAP, CI, SVI and SVRI were higher in group P than that in group C at the point of TG1(P<0.05). After insertion of acrylic cement, The number of patients with SVV>13% in both groups showed the tendency of first increased and then decreased, while it increased more significantly in group C at the point of TG1 than that in group P(P<0.05). The variation of HR had no significant difference between the two groups, or among various time points in each group(P>0.05).2. Oxygen dynamics: The Pa O2 and DO2 I in group C after insertion of cement was significantly lower at the point of TG0 and TG1 than T2(P<0.05), the Pa O2 and DO2 I in group P after insertion of cement was significantly lower at the point of TG0 than T2(P<0.05); while there was no significant difference between the two groups(P>0.05). The Scv O2 in group C after insertion of cement was significantly lower at the point of TG1 and TG2 than T2(P<0.05), but the Scv O2 among each time point in group P had a decreasing trend, but without significant difference(P>0.05); between the two groups, Scv O2 were higher in group P than that in group C at the point of TG1(P<0.05). Lactate levels in both groups were increased firstly and then decreased,while it increased more significantly in group C at the point of TG2 than group P(P<0.05).The Sa O2 between the two groups, or among various time points in each group had no significant difference(P>0.05).Conclusion 1. Hemodynamic fluctuate significantly during the induction of general anesthesia and bone cement implantation period in aged patients undergoing hip replacement surgery.2. Preventive treatment with drugs for BCIS could provide more stable hemodynamic, better organ perfusion and oxygen metabolism during the bone cement implantation period in aged patients undergoing hip replacement surgery.